| NPI | 1255824371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901022647) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022647) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2025-04-07 |